Phil Gusack Talk 2017 at AGM

Reshaping NHS Infrastructure: Will integrated care centres do the trick?

Dr Patricia Oakley is a woman on a mission. Having qualified originally as a pharmacist and becoming London Chief Pharmacist in the early 1980s she didn’t stop there. She has a masters and a doctorate; teaches and undertakes research at Kings College, London and is a Director at Practice Makes Perfect. She splits her time between London and the West Country.

On talking about building the case for change Pat told us that she talks from experience having been involved in policy making for integrated care centres. More usually she works every summer building forecasting models of the clinical workforce and particularly doctors, dentists and pharmacists in order to inform the Joint Investment group of the student numbers they need to admit to support the future workforce. These models look forward 20 years which is the time it takes for a student to become fully effective in the workforce.

At this point Pat became deliciously political, telling us how the UK only spends 6.5% of GDP on healthcare compared to France and Germany at 8-9% and the Swiss at 10%. Tony Blair moved spending on health from 5% to 10% which should be viewed as one of his most significant achievements. However it hasn’t been sustained at that level. The state also knows it requires a capital programme of £120b for healthcare.

Pat continued that the current NHS was designed for a life expectancy that was surpassed years ago. It has almost been too successful. Life expectancy and health into later life means we need a new asset class. This does not mean a return to the community hospital model (many of which were closed down but not knocked down). What is required is a care centre model creating places for care and for work.

80% of the budget within the next 30 years will be spent on care of the elderly who are physically well, socially engaged and psychologically content. These are the baby boomers who are healthier, wealthier and stealthier! It is the paradigm of chronic disease.

So, we need to think about the Mind the Gap programme that seeks to integrate mental health to close the 20 year life expectancy gap. We need to think about new science – therapeutics, genetics and molecular imaging.

Barnett et al writing in the Lancet in 2012 cited that ‘exercise is the miracle cure’. This means we must think about urban design and social space (and ban sofas!)

All this thinking is leading us to new design principles and new services such as ‘doc in a box’ and single people campuses / co-operatives. The GP practice is a ‘busted flush’ based on a 1911 model which no longer works.

So, what is the ‘place in the middle’?

This model is about placing social care; hospice and hospital at home; pharmacy and medicine; GP and community nursing and therapy on the high street. Hyper centres (the word hospital should be banned) then become about trauma; cancer; cardiac and stroke care; urgent care; maternity and neonates and mental health.

Some of this is happening already. The Nelson Centre in Wimbledon provides local care including a therapy theme park; genomics; outpatients; pharmacy; diagnostics; social space and GP adjacent to a retirement village. The model exists more widely in Denmark and the Netherlands.

Northumbria also has a pilot site.

This is about a crucible of change, happening at the centre of the community; a shared place for many professionals and new ways of working. It should become a focal point for new investment.

Pat finished by telling us we need fewer beds and fewer doctors but to deliver what is actually needed needs the construction of a persuasive, informed narrative which currently doesn’t exist.

Chris Shaw thanked Pat and said members were thoroughly engaged in this provocative and no holds barred talk. It was agreed that her passion for her subject and her knowledge of future policy requirements coupled with a style that takes no prisoners was entirely fitting for the Phil Gusack Talk 2017.


David Powell Development Director at Alder Hey Children’s NHS Foundation Trust can rightly be regarded as one of a very exclusive group within the NHS considering the total NHS workforce of 1.4m staff, David is doubtless one of handful – an expert client lead with a string of successful projects in his portfolio.

Architects for Health were delighted to welcome David Powell as guest speaker at the post-AGM presentation in February 2016. His experience and wisdom garnered over many years has most recently been applied to managing the design and construction of the Alder Hey Children’s Hospital in Liverpool – badged as the world’s first living hospital. Continue reading

20 x 2: 26/11/15

The annual light-hearted and high-speed exposition of all things healthcare was hosted by NBBJ London on 26th November 2015. A regular and popular feature of the Architects for Health programme, the headline refers to invitations to up to 20 members to present a topic of their choice for no more than 2 minutes. There is no prescribed format and content can be any topic with at least a passing nod to healthcare design and environments.

Attracting a sizeable audience which, thanks to NBBJs gracious hospitality, was keen to provide ad hoc interjections of support or otherwise, the evening heard a wide range of differing two-minute monologues with accompanying ubiquitous PowerPoints. Continue reading

IHEEM 2015 AfH Design Award Winner’s Presentations

The Architects for Health Design Awards are unique in that the winners are selected by a panel of fellow practitioners. Those designs selected for awards represent the best work in the field and expert recognition of quality and innovation. The awards, kindly sponsored by Vinci and Carillion, were made at the European Healthcare Design Congress; this event held at the Healthcare Estates Conference at the Manchester Central conference centre offered the winners an opportunity to showcase their projects.

Each winning team made their presentations at the Exhibition Theatre next to the Architects for Health stand at the event in which had accumulated an audience larger than some of the main conference events with a standing crowd spilling over onto the surrounding exhibition space.

Best New Building Award winner, The Lane Fox REMEO Respiratory Centre was presented by Marc Levinson a Partner at Murphy Philipps Architects. An outstanding health care building that helps to transform care services. Marc’s presentation illustrated the accumulation of confidently executed but modest design steps that together create an outstanding health care building.
View presentation on SlideShare

Best Conversion Project Award winner, Citylabs Manchester, this is a local and complex project that deserved a more full explanation. Tony O’Brien a Partner at Sheppard Robson set out the layered rationale behind this outstanding building conversion that brings together the NHS, academic health science communities and industry with specialist clinical resources and expertise from researchers.
View presentation on SlideShare

Best International Project winner, Ghana District Hospitals for the Ministry of Health by TP Bennett. Polly Barker and Paul Scott presented the development of a suite of modular, climate adapted local hospital campuses of varying technical sophistication using clear and very attractive graphics. Care in calibrating the design to the local context gained this project the award for an outstanding health care building located outside the UK.
View presentation on SlideShare

Best Idea Award winner, the New Cancer Centre at Guy’s Hospital was presented by Catherine Zeliotis of Stantec on behalf of her team, Rogers Stirk Harbour, Arup and Laing O’Rourke. This project is both a significant urban architectural work and an essay in rethinking clinical organisation. The vertical tower with overlapping cancer care villages marks an entirely new way of organising highly specialised treatment in a patient friendly setting.
View presentation on SlideShare

“Everything is Design. Everything!” – Paul Rand

Everything is Design. Everything.
Architects for Health at the Design Council.
17th September 2015

As a writer, thinker, graphic designer and art director for some of the most memorable corporate organisations in the USA, Paul Rand (1914-1996) believed that design is embedded into every aspect of life – Everything is Design. Everything. Exploring this at the Design Council with five speakers from widely different backgrounds, Architects for Health was first given an insight into the design of the mind.

Dr Steven Allder, a consultant neurologist, declared unhesitatingly his interest in hysteria. Through his work as a clinician and subsequently leading change in his field, he explained how initial improvements to organisations at a small scale can be relatively successful but that upscaling is challenging. The larger the challenge, the more embedded are the entrenched positions – and we are all, he believes, programmed to exist and remain in a ‘tribe’ mentality, inhibiting creativity.

His analysis of the design of the mind explores three stages or loops, with the last achieving a creative mind. However, so often, this state is rarely achieved within large corporate structures, 99% of executive teams mess up at critical moments, entirely unconsciously.

On a more positive note, Dr Allder believes that design is a social process and should be fully embedded in any social system. To understand the design of the mind gives insight into our unconscious behaviour and a way forward beyond the analytical is the power of a lesson from ancient times – to connect with our hearts.
View Dr Steven Allder’s presentation on SlideShare

Shirley Cramer, Chief Executive of the Royal Society of Public Health, has a daunting agenda to challenge widespread health lifestyle issues – smoking, drinking, inactivity and obesity – and the associated costs to the NHS annually of around £14 billion. RSPH advocates parity between mental and physical health and has evaluated aspects of how deprivation skews lifestyles.

The RSPH study “Health on the High Street” began by attributing a score – a ‘Richter scale’ of health impact – to various types of outlet. Leisure centres scored best followed by health clubs, libraries and unexpectedly, pubs. The worst offenders were payday loan shops, closely followed by bookmakers, fast food outlets and tanning salons.

This methodology was then applied to various high streets across the country with a close correlation between the overall score of the outlets and the levels of health impact locally. Results were published widely leading to some local authorities asking RSPH for assistance in improvements. Several recommendations have been drawn from the study among which are changes to planning powers for local authorities, legislation to allow differential business rates for healthier outlets and clear nutrition and calorie information at fast food shops.
View Shirley Cramer’s presentation on SlideShare

Vivienne Parry works with Genomics England as Head of Engagement. Over the last few years, the cost and speed of genome sequencing has reduced dramatically and given rise to a government sponsored programme called the 100,000 Genomes Project.

Genomics England is owned by the Department of Health and is leading the world with the aspiration to source genomics information from about 75,000 people by 2017. The ethical and data security challenges are many but the study opens up an entirely innovative approach to treatment and prevention.

The possibility of personalised medicine is within reach as genomics aspires to allow individual targeted identification and diagnosis. Vivienne Parry cited five cases of neonatal diabetes, whose condition might have been treated with the same regime: genomic analysis allowed personal assessments leading to five different and individualised treatments.

The 100,000 genomes project has the potential to change the face of medicine and treatment with ever increasing sophistication and techniques: in the future, genomics information may be possible with hand-held technology, with the subject being asked to ‘spit in a box’ – with the amusing working title of ‘Min-ion’.
View Vivienne Parry’s presentation on SlideShare

John Cooper, former Chair of Architects for Health and seasoned healthcare architect, recalled earlier robust studies and conferences optimistically heralding design in healthcare as a vital thread. He then contrasted this with the reality of the present, where central guidance is under threat, design expertise within the NHS has all but disappeared, Trust finances appear out of control and Chief Executives have seeming the lifespan expectancy of a Lancaster bomber tail-gunner.

The NHS estate continues to carry a massive and unaddressed backlog maintenance burden while agency nurse costs and negligence claims apparently soar. It is broadly the case that clinical and nursing care is first class, but has become mechanistic; that the service perspective from staff is of over-management and fragmented. Investment and strategic decisions appear irrational.

John Cooper referred to work he is doing for London Trusts where reconfiguration is expected to achieve savings and rationalisation of services. However, his view is that these exercises are flawed and influenced unduly by historical and geographic baggage as well as egos and entrenched positions.

It is a sadness that NHS/DH has apparently mislaid the power of design and the value of an integrated strategy.

As an example of a more sympathetic system; through integrated thinking, Singapore has developed facilities which are well designed, not showy, give patients unexpected opportunities such as gardening, provide excellent green spaces with tropical fish and enhancing the integrity of a healthcare environment.

The Singapore experience may be influenced by their careful strategic approach to health developments and, potently, by the existence of design teams embedded within every hospital.
View John Cooper’s presentation on SlideShare

Claire Devine, who is a Director of DC CABE, referred to the studies which had been undertaken by the Design Council including the well-received research into reducing violence in A+E departments. The Knee High Design Challenge had engaged with children under 5 and work is under way on 5 Healthy New Towns which will focus on 250 homes per year for the next 5 years. DC’s programme also includes ongoing development of their Active by Design approach.

Claire Devine welcomed Architects for Health to DC CABE’s offices and expressed the view that the two organisations could work closely together as Design Advisory Panels are formed. There has already been initial dialogue between DC CABE and some NHS Trusts and the value of Architects for Health’s input was acknowledged.

The event was made possible by the generous sponsorship of Drager and of Scott Tallon Walker, to whom Architect for Health express their grateful thanks.

South West Regional Member Event Bristol and Bath 15-16 April 2014

We were delighted to welcome a group of around 60 speakers, sponsors, and AfH members at our inaugural South West Regional Event which was held in Bristol and Bath on the 15th and 16th of April 2015 respectively. This 2 day gathering of architects and allied healthcare professionals followed a similar format to that established previously in successful visits in Cardiff, Glasgow, Manchester, and Liverpool over the last few years. During this period the annual Regional Event has become a highlight in the AfH calendar and we are already making positive plans for next year’s event in a location to be confirmed – watch this space! Continue reading

Architects for Health IHEEM Conference Session 7th October 2014

Architects for Health IHEEM Conference Session 7th October 2014
Procurement of design services – the good, the bad and the future

With the greater majority of design services for the NHS – architects, engineers, cost consultants and the like – employed in the private sector; and the parallel rise of procurement specialists and hubs associated with the NHS, the position could be portrayed as an increasing divide. The Architects for Health session on 7th October explored the evolution of the relationship between those who commission designers and those who provide those services, and rounded off with a pair of challenges to take forward.

Chaired by Paul Mercer, former AfH Secretary and aided and abetted by Claudia Bloom of Avanti Architects and Malcolm Aiston, Director of Estates and Facilities for Northumberland Tyne and Wear NHS Foundation Trust, the session opened up a difficult topic which seemed to strike a chord with the audience who could be heard recounting the topic throughout the rest of the day. Continue reading